tbuckley/cabot-search huggingface dataset:
Abstract 13300: Cardiac Structural and Functional Characteristics Are Associated With Left Atrial Appendage Thrombus Formation in Non-Valvular Atrial Fibrillation
Authors: Carson Castellani, Hyun Kim, Colton Thompson, John Ning, Kaiwei Lu, Nicole L Lohr, Sudhi Tyagi, Aimee C Welsh, Marcie Berger
Journal: Circulation (2022)

Introduction: Non-valvular atrial fibrillation (NVAF) is a highly prevalent arrhythmia where loss of synchronized atrial contraction increases the risk of intracardiac thrombus particularly within the left atrial appendage (LAA). Anticoagulation is the mainstay of stroke prevention based on the CHA2DS2-VASc score that does not account for LAA structural characteristics. Methods: The research comprises a retrospective case-control study of 196 subjects with NVAF who underwent TEE. The control group, without thrombus (n=117), was selected from two different groups, both pools had: NVAF and CHA2DS2-VASc score ≥ 3. One group underwent screening TEE prior to Watchman closure device placement from January 2015 to December 2019 (n=74) the second underwent TEE for any indication from February to October 2014 (n=43). The study group, with thrombus (n=79), included patients with NVAF, a TEE study performed between February 2014 and December 2020, and LAA thrombus. LAA ostial areas (calculated from orthogonal measurements 0, 90° or 45, 135°), maximal depth, and peak outflow velocity were measured, and the rhythm during TEE was interpreted. The control and study groups were compared using Student’s or Welch’s t-test based on variance ratios. Results: Patient characteristics and TEE data were collected (Table 1). Patients in the control group compared to the study group had significantly greater LV EF, LAA exit velocities, LAA ostial areas, and maximal LAA depth, and were more likely to be in sinus rhythm at the time of TEE. There were no significant differences between the groups in overall CHA2DS2-VASc scores. Conclusion: Cardiac structural and functional characteristics are associated with left atrial appendage thrombus among patients with NVAF.
Abstract 12995: Use of Percutaneous Septal Closure Device for Paradoxical Cerebral Fat Emboli in a Young Female With Patent Foramen Ovale
Authors: Kevin Thompson, Anum Asif, Almomani Ahmed
Journal: Circulation (2022)

Introduction: Cerebral fat emboli (CFE) is a rare (0.9-2.2%) and fatal complication (up to 10% mortality) after burst fractures of the long bones. Studies have reported a worse prognosis with the concomitant presence of a patent foramen ovale (PFO) by allowing a portal to reach systemic circulation, which could be preventable with closure devices; however, it remains unexplored. Clinical Case: 23-year-old female without any medical history, admitted to trauma ICU after a high-energy motor vehicle collision resulting in left femur open fracture, ribs, vertebral fractures, and left-sided pneumothorax. She was intubated due to poor mental status. CT head was unremarkable, but subsequent brain MRI showed multiple punctate foci of hyperintensity in the bilateral white matter of cerebral hemispheres, corpus collosum, cerebellum and brainstem, representing fat embolism (Figure). Transthoracic and transesophageal echocardiography confirmed a small PFO. After a multidisciplinary team discussion, PFO closure via Amplatzer device was done to reduce the risk of systemic embolism burden. Discussion: In patients with long bone fractures, right-to-left shunts from PFOs have been shown, by transcranial doppler (TCD), to be associated with larger and frequent micro embolic signals (MES) in the brain. TCD has also shown decreased embolic load and significant reductions in the size of emboli that make it to cerebral circulation after successful percutaneous closure of PFOs. Similar results are seen in prospective high-risk long bone fractures before orthopedic interventions. This suggests there could be a potential role of closure devices in such trauma patients with PFO. Conclusion: There could be a potential role of closure devices in selected trauma patients with paradoxical cerebral embolism and a PFO, however, the benefits of long-term outcomes need to be explored in larger cohorts.
Abstract 13217: Optimizing Longitudinal Retention in Care Among Patients With Hypertension in Primary Healthcare Settings: Findings From the Hypertension Treatment in Nigeria Program
Authors: Jiancheng Ye, IKECHUKWU ANTHONY A ORJI, Abigail Baldridge, Tunde Ojo, Grace Shedul, Eugenia Ugwuneji, NONYE EGENTI, Kasarachi Omitiran, Rosemary Okoli, Helen Eze, Ada Nwankwo, Lisa Hirschhorn, Aashima Chopra, Boni Ale, Gabriel Shedul, Namratha Kandula, Mark D Huffman, Dike Ojji
Journal: Circulation (2022)

Introduction: Previous hypertension research has evaluated retention using cross-sectional study designs. However, longitudinal analyses are likely more useful to identify areas for improving retention. Objective: To describe longitudinal retention patterns among patients with hypertension in primary care in 6 Federal Capital Territory council areas in Nigeria. Methods: The Hypertension Treatment in Nigeria Program implemented a multi-level intervention package in 60 centers in Nigeria. Baseline and follow-up data were collected from January 2020 to December 2021. Healthcare workers scheduled patients for a follow-up appointment at each visit, for which one month was recommended. Retention was measured by the patient presenting to the clinic for a follow-up visit within 7 days of the scheduled appointment. Results: 14,346 patients (68.7% female, mean [SD] age = 49.1 [12.6] years) were included with 61,320 documented visits, among which 14,975 were registration visits and 46,345 were follow-up visits. 9,490 (66.2%) patients had ≥1 follow-up visit. Fig 1 demonstrates longitudinal patterns for 37-day retention by council area, in which Kuje has the highest follow-up rate (55.6%) while variability was seen across areas. The median (IQR) time to the scheduled appointment was 30 days (28, 31), and observed time to follow-up visit was 32 days (29, 42). 40,759 (66.5%) appointments were scheduled ≤ 30 days, 58,773 (95.8%) appointments were scheduled ≤ 37 days, and 282 appointments (0.5%) were scheduled ≥ 60 days after the previous visit. Among documented follow-up visits, 16,524 (35.7%) occurred within 30 days of the prior visit, 32,145 (69.4%) occurred within 37 days, and 31,344 (67.6%) were within 7 days of the scheduled appointment. Conclusions: Retention in hypertension is widely variable within individuals, over time, and across council areas. Longitudinal retention analyses provide robust assessments to develop tailored strategies to improve retention.
Abstract 12892: Cumulative Weight, Adipokines, and Hypertension
Authors: Eric K Broni, Erin D Michos, Sui Zhang, Justin B Echouffo Tcheugui, Roberta Florido, VIJAY NAMBI, Layla Abushamat, Wendy S Post, Gary Gerstenblith, Roger Blumenthal, Ron C Hoogeveen, Christie M Ballantyne, Josef Coresh, Elizabeth Selvin, Chiadi E Ndumele
Journal: Circulation (2022)

Background : Chronic obesity is a major risk factor for hypertension, and obesity-associated hypertension is often difficult to control. Adipokines have vascular effects, but the degree to which they mediate the association between chronic obesity and hypertension is unknown. Methods: We conducted a cross-sectional analysis of 10,842 ARIC participants who attended Visit 3 (1993-95) with self-reported BMI at age 25 and measured BMI at visits 1 to 3 (each 3 years apart). We calculated cumulative excess BMI years by centering BMI at 25 kg/m 2 at each time point and multiplying the mean BMI by the duration in years from age 25 to Visit 3. We categorized cumulative excess BMI years by quartiles. Plasma adipokines (leptin, adiponectin) were measured at Visit 3. Prevalent hypertension at Visit 3 was defined as blood pressure ≥130/80mmHg or hypertension medication use. We used linear regression to assess associations between cumulative BMI quartiles and adipokines (log transformed). We used logistic regression to assess the association of cumulative BMI with prevalent hypertension and the extent to which adipokines mediate this relationship. Results: Higher quartiles of cumulative excess BMI years were associated with lower adiponectin and higher leptin levels (both p&lt;0.001). Higher cumulative excess BMI years was strongly associated with hypertension (OR 2.52 [95% CI 2.21, 2.87], for top vs bottom quartile). Adiponectin partially mediated the association of cumulative excess BMI years with hypertension by 7% (OR for top quartile decreased from 2.52 to 2.41), leptin mediated the association by 18% (OR decreased from 2.52 to 2.24), and the combination of adiponectin and leptin mediated the association by 22% (OR decreased from 2.52 to 2.18) ( Table ). Conclusion: Adipokines may partially mediate the association of long-term excess adiposity with hypertension. Targeting adipokines may have therapeutic value in managing hypertension in those with chronic obesity.
Abstract 13270: Seasonal Variation in In-Hospital Outcomes of Takotsubo-Syndrome-Related Admissions: A National Inpatient Analysis, 2019
Authors: Rupak Desai, Samuel Edusa, Rabia Naseem, Aditya Sharma, Aakash Desai, Yash Patel, Ibadat Anmol Singh, Gurmannat SIngh Kang, Shilpa Reddy, Sonal Devi Duggirala, SAMIR STANIKZAI, Akhil Jain
Journal: Circulation (2022)

Background: Contemporary literature lacks data on the impact of climatic variations on the etiopathogenesis and outcomes of Takotsubo Syndrome (TTS)-related hospitalization in the U.S. Methods: Seasonal variation was identified based on meteorological classification of the northern hemisphere Spring, Summer, Fall and Winter using data from the National Inpatient Sample (2019) and odds of outcomes were assessed using multivariable regression models. Results: The TTS cohort (n=41830) in 2019 was mostly caucasian (80.6%), female (82.1%), and median age ≥65yrs (61.9%). Fall (25.9%) admissions were the highest, followed by summer (25%), spring (24.6%) and winter (24.5%). Despite a similar median length of stay (4-days; p&lt;0.001), winter hospitalization expenditures (USD56763) were the highest and fall lowest (USD51649). Winter admissions had greater all-cause mortality (7.3%vs.6.7%) and dysrhythmias (29.8%vs.28.5%), including Atrial fibrillation (AF) (20.7%vs. 19.7%). Admissions in spring had a higher cardiac arrest (4.8%vs.4.1%) and Acute Venous Thromboembolism (VTE) (4.7%vs.3.5%) compared to overall TTS-related admissions. When adjusted for confounders, a higher risk of dysrhythmias was noted for [winter (OR:1.20; 95%CI:1.03-1.39), Spring (OR:1.15;95%CI:1.00-1.33) and Fall (OR:1.18;95%CI:1.03-1.36) vs. summer; p=0.063]. A higher risk was also noted for AF in winter (OR:1.22;95%CI:1.02-1.45), Spring (OR:1.20;95%CI:1.02-1.42) and Fall (OR:1.28;95%CI:1.08-1.51) when compared to summer; p=0.028]. Spring admissions had a greater risk of VTE than summer admissions [(OR:1.54;95%CI:1.09-2.16) vs. summer; p=0.067]. Other outcomes, such as all-cause mortality and cardiogenic shock, had an association after controlling for confounding variables. Conclusions: Compared to Summer, Winter hospitalizations increased the risk of dysrhythmia and AF, while Spring admissions revealed a higher risk of VTE.
Abstract 13378: Association Between Social Connection and Biological Age as Determined by Artificial Intelligence-Enabled Electrocardiography
Authors: Nazanin Rajai, Jose R Medina-Inojosa, Mohammad Ali Sheffeh, Abraham Baez Suarez, Mark A Nyman, Zachi Attia, Lilach O Lerman, Betsy Medina-Inojosa, Francisco Lopez-Jimenez, Amir Lerman
Journal: Circulation (2022)

Introduction: Increasing evidence unravels the role of loneliness and social connection in cardiovascular diseases potentially mediating accelerated biological aging. The present study aims to explore the association between social connection and biological aging as determinate by artificial intelligence-enabled electrocardiography (ECG). Methods: This is an observational retrospective cohort of adults aged ≥18 seen at Mayo Clinic from 2019-2022 who completed the social determinants of health questionnaire and had a 12-lead ECG within one year of completing the questionnaire. Five questions were asked to understand each patient’s social connection . The answers were scored to assess their level of social connection from socially isolated (score of 0) to socially connected (score of 4). The biological age was predicted from ECGs using the previously developed convolutional neural network (AI-ECG age). Delta age (Δage) was defined as AI-ECG age minus chronological age, where positive values reflect an older than expected age. Results: We included 280,323 subjects (chronological age 59.7±16.4 years, 51% female). The average AI-ECG age was 59.5±13.5 year. Better social connection status correlated with lower delta age (β=-0.33 (95%CI, -0.38 and -0.28, p&lt;0.001, adjusted to chronological age and sex). Conversely, individuals reporting the least social connection were an average of 2 years older than expected whereas those with the most social connection were 2 years younger than expected by AI-ECG (Figure 1). Conclusions: Social connection is strongly associated with slower biological aging compared to chronological aging, independent of the conventional cardiovascular risk factors. This observation underscores the need to address social connection as a healthcare determinant.
Abstract 14170: Ratio of Early Transmitral Inflow Velocity to Early Diastolic Strain Rate Predicts Atrial Fibrillation Following Acute Myocardial Infarction
Authors: Caroline L Bjerregaard, Flemming J Olsen, Mats Lassen, Thomas Fritz-Hansen, soeren galatius, Allen Z Iversen, Sune H Pedersen, Tor Biering-Sørensen
Journal: Circulation (2022)

Background: The ratio of early transmitral filling velocity to early diastolic strain rate (E/e’sr) has been proposed as a new measurement of left ventricular filling pressure. We aimed to investigate the ability of E/e’sr to predict atrial fibrillation (AF) after ST-elevation myocardial infarction (STEMI). Methods: This was a prospective cohort study of patients with STEMI treated with primary percutaneous coronary intervention (pPCI). Patients underwent an echocardiographic examination a median of two days after pPCI. By echocardiography, transmittal early filling velocity (E) was measured by pulsed-wave Doppler, and early diastolic strain rate (e’sr) was measured by speckle tracking of the left ventricular. The E was indexed to e’sr to obtain the E/e’sr as well as to the early myocardial relaxation velocity to obtain the E/e’. The endpoint was new-onset AF. Results: During follow-up (median 5.6 years, IQR:5.0-6.1), 23 of the 369 patients developed AF. In unadjusted analyses, both E/e’sr and E/e’ were significantly associated with AF [E/e’sr: HR=1.06; (1.03-1.10); p&lt;0.001, per 0.1 increase] and [E/e’: HR=1.11 (1.05-1.17); p&lt;0.001, per 1 increase] and had equal Harrell’s C-statistic of 0.71. However, only E/e’sr remained an independent predictor after multivariable adjustments for clinical and echocardiographic parameters [E/e’sr: HR=1.06 (1.00-1.11); p=0.042, per 0.1 increase] and patients with high E/e’s compared to those with a low E/e’sr had and almost four-fold risk of AF during follow up (HR=3.85 (1.43-10.35), p&lt;0.02) (figure). These findings were unchanged in competing risk analyses accounting for death as a competing event. E/e’sr was also significantly associated with AF in patients with normal filling pressure by E/e’ (HR=1.07 (1.01-1.17); p=0.030, per 0.1 increase). Conclusion E/e’sr is an independent predictor of AF in STEMI patients, even in subjects with seemingly normal filling pressure.
Abstract 14789: Vascular Growth Factors and Their Association With Arterial Stiffness in the 1986 Jamaica Birth Cohort: A Longitudinal Analysis
Authors: Nadia R Bennett, Trevor S Ferguson, Novie O Younger-Coleman, Marshall Tulloch-Reid, Rainford Wilks, J K Cruickshank
Journal: Circulation (2022)

Introduction: Vascular growth factors (VasGFs) and increased arterial stiffness provide an early indication of structural and functional blood vessel changes that lead to cardiovascular disease. We aimed to determine if there was an association between serum levels of vascular endothelial growth factor (VEGF), epidermal growth factor (EFG), angiopoietin 1 (Angp1) and angiopoietin 2 (Angp2) with arterial stiffness in 28-30-year-old adults from a birth cohort. Methods: Participants were a subset of members of a longitudinal study of children born in Jamaica between September and October 1986. Sociodemographic and anthropometric measurements were taken at the 18-20 and 28-30 follow-up visits, while serum was collected at the 18-20 year old visit. The pulse wave velocity (Arteriograph TM ) was used to measure arterial stiffness at the 28-30-year-old visit. Analyses were limited to participants who had pulse wave velocity measurements. Multiple imputation using chained equations was done to account for missing data on the explanatory variables. Linear regression models were used to explore bivariate associations. The final multivariable model included VEGF, EGF, Angp1, Angp2, age, sex, BMI, SBP, DBP, smoking and education. Results: Analyses included 387 participants (47% male). At 18-20yrs median serum concentrations of VEGF 75.4 pg/ml; EGF 951.4 pg/ml; Angp1 67863.7 pg/ml; and Angp2 691 pg/ml. At 28-30 there were sex differences in BMI (M:25.2 vs F:28.8kg/m 2 ), SBP (M:114 vs F:108 mmHg), current smokers (M:29% vs F: 5.4%) tertiary education (M:22% vs F:39%) and arterial stiffness (M:6.4 vs F:6.8m/s). In the final multivariable model both VEGF and EGF were associated with arterial stiffness. VEGF coef (95%CI) 0.095 (0.014, 0.176) p= 0.022 and EGF -0.087 (-0.169, -0.004) p =0.039. There was no association between angp1 or angp2 and pulse wave velocity. Conclusion: VEGF concentrations at 18-20 of was positively associated with arterial stiffness at 28-30 years old, while and EGF showed inverse association. VEGF and EGF may be useful biomarkers of vascular function in young adults.
Abstract 14862: Development and Validation of a Phenomapping Tool to Identify Patients With Diuretic Resistance in Acute Decompensated Heart Failure: A Multi-Cohort Analysis
Authors: Matthew W Segar, Mohammad S Khan, Kershaw Patel, Javed Butler, Ashwin Ravichandran, Ashwin Ravichandran, Mary N Walsh, Duwayne Willett, Gregg C Fonarow, Mark H Drazner, Robert J Mentz, Jennifer L Hall, MaryJane Farr, Susan Hedayati, Clyde W Yancy, Larry A Allen, Wai Hong W Tang, Ambarish Pandey
Journal: Circulation (2022)

Introduction: Individuals presenting with acute decompensated heart failure (ADHF) have varying response to diuretic therapy and short- and long-term prognosis. Hypothesis: If machine learning can risk stratify patients with ADHF and identify subgroups at risk for diuretic resistance. Methods: Participants with ADHF from the ROSE-AHF and CARRESS-HF clinical trials were included (n=451) and clustered using multivariable finite-mixture models based on diuretic efficiency (fluid output over first 72 hours per total intravenous loop diuretic dose). Differences in diuretic efficiency, in-hospital length of stay, and in-hospital mortality were assessed using linear and logistic regression models. Phenogroups were externally validated in trial (DOSE/ESCAPE, ATHENA-HF) and real-world (GWTG-HF) cohorts. Results: Clustering identified 3 phenogroups. Participants in phenogroup 1 (n=271, 60%) had worse diuretic efficiency [median(IQR) = 11.6(6.6-17.9) mL/mg) compared with phenogroups 2 (n=145, 32%) and 3 (n=35, 8%) [median(IQR) = 16.3(11.2-23.9) and 20.2(12.3-49.9) mL/mg, respectively; p&lt;0.001]. An integer-based risk score to predict phenogroup 1 (lowest diuretic efficiency) was created: BAN-ADHF ( Fig. ). Net urine output was 2600 vs. 1090mL per 24 hours in patients with scores of 5 and 15, respectively ( Fig ). In the external validation cohorts, participants with scores ≥11 vs. &lt;11 had significantly lower global well-being, higher natriuretic peptide levels on discharge, longer length of stay, and higher risk of in-hospital mortality. Conclusions: We developed and validated a phenomapping strategy and risk score for individuals with ADHF and differential response to diuretic therapy, which was associated with length of stay and mortality.
Abstract 13689: A Case of Myopericarditis Caused by Salmonella
Authors: Danni Fu, Brian Yuen
Journal: Circulation (2022)

Introduction: Salmonella is a gram-negative bacteria that usually causes self-limiting diarrhea. It is a rare infectious etiology of myopericarditis. Here we present a case of a young healthy male with Salmonella diarrhea who developed myopericarditis. Case: 26 year-old male with no medical history presented with chest pain for several hours, improved by sitting upright. He also endorsed fevers, watery diarrhea, nausea, and body aches for the past 5 days. Vital signs and physical exam were within normal limits. Complete blood count and comprehensive metabolic panel were unremarkable but high sensitivity troponin T was 125 and peaked at 434. ESR and CRP were elevated. EKG showed minimal up-sloping ST-elevations diffusely with PR-elevation in lead aVR. Chest X-ray was clear. Patient was started on aspirin, clopidogrel, heparin drip, and low dose beta-blocker for empiric treatment of acute coronary syndrome as well colchicine for pericarditis. Transthoracic echocardiogram showed normal ventricular functions and no pericardial effusion. Cardiac MRI showed myocardial late gadolinium enhancement involving the outer wall of the lateral, inferolateral, and inferior walls of the basal left ventricle corresponding to myocarditis. At this point heparin was stopped and patient was transitioned to high dose aspirin with resolution of chest pain. He was continued on the beta-blocker for arrhythmia prevention in the setting of myocarditis. All infectious work up including respiratory viral panel, COVID PCR and antibodies, and blood cultures were unremarkable except stool PCR that was positive for Salmonella species. Infectious disease was consulted and he was given one dose of ceftriaxone and 7 days of azithromycin. Patient was discharged with close follow-up. Conclusions: Salmonella myopericarditis is rare and more often described in immunocompromised patients. Our case highlights this condition in an immunocompetent male. Cardiac treatment is supportive with volume optimization and arrhythmia prevention. Early liaison with infectious specialists in treatment of the infection is important given various region-dependent antibiotic susceptibilities.